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FL-470Mandatory

Application And Order For Health Insurance Coverage

California · Judicial Council of California · Effective January 1, 2007

This form is used to ask a judge to order a parent's employer or another person who provides health insurance to include the children in the health insurance coverage. It also includes an order that tells the employer what they must do.

The court describes it as: Ask the judge to make the employer of a parent include the children in their health insurance coverage. It also tells the employer to include the children in the health insurance.

Open the official PDFfrom Judicial Council of California

Where this fits in a case

Start a case

Stage: Start a case

This form is used when a party needs the court to make sure that a parent's job or another source of insurance keeps the children covered by health insurance.

Usually filed by the person starting the case.

Common questions

Who fills out this form?
The applicant fills out the application part of the form. The employer or person providing insurance signs the declaration part. The court issues the final order.
What does the employer have to do after getting this order?
The employer is ordered to start or keep the children covered by health insurance. They must also give the parent a copy of the order within 10 days.
What if the employer cannot provide coverage?
If no health insurance coverage is available, the employer must complete and sign a Declaration of No Health Insurance Coverage and mail it within 20 days.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect January 1, 2007.

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